Autism therapy method incorporates play

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•The most recent prevalence data from the U.S. Centers for Disease Control and Prevention estimates 1 in 68 U.S. children has been diagnosed with autism spectrum disorder (ASD), which is 30 percent higher than 2012 estimates.•ASD is nearly five times more common in boys than girls.•Most children with ASD are diagnosed after age 4, even though it can be diagnosed as early as age 2.•About 50 percent of children with ASD have average or above average intellectual ability.•As of 2013, Asperger's syndrome and other forms of autism are not differentiated but fall under one umbrella diagnosis, autism spectrum disorder (ASD).

ICAN Inc. and Paytons Place, 409 E. Cook Road, Suite 100, in the Stone Pointe Office Park, is hosting an open house 3-7 p.m. April 17. For more information about the nonprofit agency and services offered, visit www.ican-autism.com) or call 487-4226.

A column by Jennifer L. Boen

Monday, April 7, 2014 - 12:01 am

Auburn first-grader Hayden Widner taught himself to read words before he was 2 years old. His mother, Erica Purdy, recalls, “He was reading sentences in books at age 3.” Despite his advanced cognitive skills in some areas, he lagged in other developmental domains such as large motor skills and displayed some concerning behaviors.

“He never wanted to be on the floor as a baby. Then as he got older he would line up his toys across the floor and get mad if I moved them. He would rock side to side,” she said. She raised her concerns with Hayden's pediatrician at the time but was told if there were issues, they would be addressed when he started school. A psychologist who Purdy consulted told her nothing was wrong with her son, but Purdy said she knew differently.

The family doctor eventually referred Hayden to psychologist Marla Souder in Indianapolis, who specializes in assessment and treatment of children and adults with autism. Souder confirmed Purdy's suspicions: Hayden had a form of autism called Asperger's syndrome, which is on the high-functioning end of the autism spectrum.

For more than a year, Hayden and his mother traveled to Indianapolis weekly for therapy using a method called DIR/Floortime. DIR is short for Developmental, Individual Difference, Relationship-based. These days, Purdy has a much shorter drive because Souder has relocated her practice to Fort Wayne.

The nonprofit Interdisciplinary Community Autism Network (ICAN) and Paytons Place opened in March at 409 E. Cook Road in Stone Pointe Office Park. Souder, an Auburn native, said she moved back to the region after seeing a need in northeast Indiana for assessment and treatment services for individuals with autism.

Souder and her staff, which includes licensed clinical social worker Bobbie Golani, occupational therapist Belinda Burton and lead case manager Lucas Souder also provide diagnostic and therapy services for other developmental and mental health disorders. Speech and physical therapists will be added soon.

A crucial member of the team is Payton, a Bernese mountain dog and trained therapy dog who helps calm patients, picks up on their nonverbal cues and helps bridge a connection between a child and the therapist, Souder said. Lola, a French bulldog, is a therapy dog-in-training at ICAN and Paytons Place.

Relational vs. behavioral focused

In the Midwest, DIR/Floortime is a lesser-known treatment model for children with autism, Souder said, but it is gaining acceptance and is recognized by national autism organizations and experts. Developed by the late Dr. Stanley Greenspan, a psychiatrist and professor at George Washington University Medical School, DIR/Floortime is a multidisciplinary approach that centers on the child's natural emotions and interests. Sessions include active participation by parents and siblings.

“Families must replicate what we do here at home,” Souder said.

The focus is not on changing inappropriate behaviors, as is more the focus of Applied Behavior Analysis (ABA), which has been considered the gold standard in autism therapy, but in meeting the child where he or she is emotionally. The method takes into account the child's feelings, relationships and individual differences. It is less about isolating and changing behaviors through rewarding good behavior and more about skill-building through connecting relationally.

For example, if the child is playing with a toy car, moving it back and forth on the floor, the DIR/Floortime therapist will pick up a car and do the same thing. But the therapist may add language, perhaps saying, “Beep-beep.” If eye contact is made, the adult reinforces the connection with a smile and laughter and a circle of communication is achieved.

Children with autism often become hyper-focused. A child may spend an hour or more playing with a string. In Floortime, the therapist also plays with a string but after a time, pretends the string is a snake or plays hide-and-seek with it. Children with autism have a difficult time understanding that just because they don't see an object doesn't mean it doesn't exist. The goal is to help the child experience and learn through playful fun, moving them to greater emotional and intellectual development.

“We meet them where they are with the hyper focus, but we shift it,” Souder explained. “We work on strength-based stuff and build on that.” That doesn't mean a child's inappropriate behaviors are ignored. Souder said, “We bring down our tone and bring down our movements if (children) are getting out of sorts. We teach them how to regulate themselves.”

Purdy says the method is helping Hayden.

“Right now, Hayden's having a hard time sharing with his little brother, who is 3. We've used role playing in Floortime to help him learn to not hit his brother or throw things. It is working,” she said.

Souder acknowledges that principles of ABA are also of value and incorporates both treatment methods with some children.

If requested, Souder goes with parents to meet with teachers and guidance counselors, noting, “We want to be a partner with anyone who works with the child.”

Jennifer L. Boen is a freelance writer in Fort Wayne who writes frequently about health and medicine. This column is the personal opinion of the writer and does not necessarily reflect the views or opinion of The News-Sentinel.